Bleeding During Pregnancy

Bleeding in early pregnancy is common, occurring in up to 25% of pregnancies. Vaginal bleeding in pregnancy has many causes. In many cases, it does not signal a major problem. 

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‍What causes bleeding in early pregnancy?

Light bleeding or spotting can occur 1 to 2 weeks after fertilization when the fertilized egg implants in the lining of the uterus.

The cervix can also bleed more easily in pregnancy because more blood vessels are developing in this area. 

It is not uncommon to have spotting or light bleeding after sexual intercourse or after a PAP test or pelvic exam.

‍Subchorionic hematoma (SCH) - This is when bleeding occurs between the wall of the uterus and the pregnancy sac. It is a common finding on early pregnancy ultrasound and is a frequent cause of light to moderate bleeding. In most cases, the blood is slowly reabsorbed by the body and the pregnancy continues normally. Many people go on to have healthy pregnancies. 

‍Ectopic pregnancy - An ectopic pregnancy occurs when the fertilized egg implants outside the uterus (most often in the fallopian tube) This type of pregnancy cannot develop normally and can become dangerous if it grows and causes internal bleeding. Symptoms may include vaginal bleeding, lower abdominal or pelvic pain, shoulder pain, dizziness or fainting.If these symptoms occur, an ultrasound exam may be done to check whether or not the pregnancy is within the uterus. Blood tests to measure the bHCG levels may be done. The bHCG test often has to be repeated multiple times to confirm an ectopic pregnancy. 

‍Miscarriage - Sometimes, bleeding does end in pregnancy loss. It happens in about 20% of pregnancies. Bleeding and cramping are signs of early pregnancy loss, although some miscarriages are diagnosed on ultrasound before symptoms occur.

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How do I find out the cause of my bleeding? 

An ultrasound may be ordered to determine if the pregnancy is developing as expected. A blood test (beta-HCG) may be obtained and compared to previous and/or future levels to determine if the pregnancy is developing as expected. A pelvic exam may be performed so your healthcare provider can look at your cervix if there are concerns for infection.

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What are the next steps? 

It is usually recommended that you refrain from vigorous exercise, heavy lifting or sexual intercourse until after the visible bleeding has resolved. Follow up will be as directed by your physician.

You should go to the nearest Emergency department if:

• Have severe pain in your abdomen
• Have very heavy bleeding (soaking ≥1 pad/hour for more than two hours, or passing large clots) or are passing large clots.
• Suddenly feel faint, dizzy, or like you are passing out
• Have chills or a fever higher than 38°C